Gittins: If you're richer, you're healthier

It's a well established fact and most of us have at least heard of it. It's also a surprising fact. But it's a fact that doesn't get nearly as much attention as it deserves - not from our politicians, the media or the public.

It's known to social scientists and medicos as the ''social gradient'' or the ''social determinants of health''. And it means there's a strong correlation between socio-economic status and health. The higher your status, the better your health.

To put it the other way, the lower a person's social and economic position, the worse their health. And the health gaps between the most disadvantaged and least disadvantaged socio-economic groups are often very large.

Illustration: Kerrie Leishman

One organisation that's taken a great interest in the phenomenon is Catholic Health Australia. It has commissioned the national centre for social and economic modelling (NATSEM) at the University of Canberra to produce two reports on the subject, one of them released this week. It has also produced a policy paper of its own. I'll be drawing on all three documents.

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You may think the explanation is pretty obvious: the more money you've got, the better health care you can afford. You can also afford a more nutritious diet. And the better educated you are, the more aware you're likely to be of the risks to health from smoking, excessive drinking and insufficient exercise.

These things are part of it, no doubt, but it's not that simple. Medicare is, after all, free or cheap to all. And who doesn't know that smoking damages your health?

There's growing evidence that status and power affect health. The lower you are in the hierarchy, the worse your health is likely to be. A fair bit of it seems to be psychological.

A study of men in England found life expectancy of 78.5 years for a professional worker, 76 years for a skilled non-manual worker and 71 years for an unskilled manual worker.

According to a paper by the American College of Physicians, job classification is a better predictor of cardiovascular death than cholesterol level, blood pressure and smoking combined. And non-completion of high school is a greater risk factor than biological factors for the development of many diseases.

The earlier report from NATSEM found that if people in the most disadvantaged areas of Australia had the same death rate as those in the most advantaged areas, up to two-thirds of premature deaths would be prevented.

Among Australians aged 25 to 44, only 10 per cent of those who are least disadvantaged report having poor health, whereas for those who are most disadvantaged it's up to 30 per cent. Among Australians aged 45 to 64, the most disadvantaged are up to 40 per cent less likely to have good health than the least disadvantaged.

Early high school leavers and those who are least socially connected are 10 per cent to 20 per cent less likely to report being in good health than those with a tertiary education or a high level of social connectedness.

Those Australians who are most socio-economically disadvantaged are twice as likely as those who are least disadvantaged to have a long-term health condition. More than 60 per cent of men in jobless households report having a long-term health condition or disability, and more than 40 per cent of women.

The socio-economic factors best at predicting whether people smoke are education, housing tenure (whether you rent, are paying off your home or own it outright) and income. Less than 15 per cent of individuals with a tertiary education smoke.

Among women aged 25 to 44, less than 20 per cent of those in the most advantaged socio-economic classes are obese, compared with up to 30 per cent of those in the most disadvantaged classes. The likelihood of being a high risk drinker for younger adults who left school early is up to two times higher than for those with a tertiary qualification.

See what this is saying? There are two ways to improve the nation's health. One way is to spend a lot more taxpayers' money on health care. That's the solution we're always hearing about, especially from doctors.

The other way is to reduce socio-economic disadvantage; to narrow the gap between the top and the bottom, not just in income but also in educational attainment (completing secondary education), housing tenure (more affordable rental accommodation) and the way people are treated at work.

This is the solution we rarely hear about. It too would cost money, of course. But it would make more people happy as well as healthy. And it would also save taxpayers money. Just how much is what NATSEM attempts to estimate in this week's report.

If the health gaps between the most and least disadvantaged groups were closed (an impossible ideal, but one we could work towards), up to 500,000 Australians could avoid suffering a chronic illness. Up to 170,000 people could enter the labour force, generating up to $8 billion a year in extra earnings.

That would produce savings in welfare payments of up to $4 billion a year. Up to 60,000 fewer people would need to be admitted to hospital annually, producing savings of $2.3 billion. Up to 5.5 million fewer Medicare services would be needed each year, saving up to $275 million. And up to 5.3 million fewer prescriptions would be needed each year, saving the pharmaceutical benefits scheme up to $185 million a year.

But the real point is that when we choose to allow the gap between rich and poor to widen each year - including by allowing the dole to stay below the poverty line - we're casting a blind eye to the ill health it causes.

174 comments

I't's a pity Ross didn't include the effects of sguar on health. A poor diet is usually a sweet diet. And sugar, fructose in particular, is poison! It damages the appetite control system,enabling people to eat whenthey are not hungry. It a,lso damages the insulin control system, resulting in Type-2diabetes for many. And most of it goes directly to the liver where it is converted to fat.

Commenter

kiwijohn

Location

wauchope,nsw

Date and time

June 06, 2012, 8:08AM

I am afraid the ignorance is the most hazardous thing that can affect your health. So called "nutrition science" about every two years tells us that everything they told us before was not correct and now they have final truth.

You do not have search too far for examples. Since when fructose has become a poison? It is 8 times sweeter than sucrose (domestic sugar) - therefore you need 8 times less fructose to achieve the same sweetness as you need sugar.Even more weirdly - if fructose is a poison - than almost all fruits and some vegetables are poison.

Commenter

Michael

Location

Sydney

Date and time

June 06, 2012, 9:04AM

Doctor Karl has refuted this, stop peddling misinformation.

Commenter

James from Brisbane

Date and time

June 06, 2012, 9:10AM

kiwijohn - I think you (& others below) are missing the point Ross was making. i.e. By looking at "The other way is to reduce socio-economic disadvantage;....." the problems of sugar, obesity, smoking, and excessive drinking, road accidents, etc. should be reduced.

Commenter

Yachtie

Location

Maroubra

Date and time

June 06, 2012, 9:20AM

"...The other way is to reduce socio-economic disadvantage; to narrow the gap between the top and the bottom..."

The lower classes are poor because of fundamental character flaws: Poor impulse control, high time preference, laziness and a lack of work ethic.

These same character traits also result in poor health outcomes.

It takes planning, foresight and manual effort (money is not a problem because preparing your own food from whole ingredients is far cheaper than eating junk food, and we know the poor eat too much of that) to prepare a meal.

Handing out more money or such other hare brained schemes will not fix the problem. It will make the problem worse.

Self control, discipline and future (rather than present) orientation needs to be cultivated as a person virtue. The state can only hinder such a process. All forms of state welfare contribute to the disincentive for poor to act like adults and to take care of themselves.

Commenter

alfredC

Date and time

June 06, 2012, 9:36AM

Yes Michael, too much of an otherwise inert food can be toxic at high levels. Arsenic from almonds is an example. The evolved human animal is geared for the occasional sugar treat, but the body struggles with the volumes the average westerner consumers. It’s worth doing a count of how many teaspoons of sugar you are getting in your daily intake. All of the following can have5-6+ teaspoons: cereal, muesli bars, coke, yogurt etc. It’s easy to be getting 30+ per day even on what we think is a healthy diet.

Are you the same Michael spamming the property section with propaganda about the ‘health’ of the real estate market and the same Michael sprouting delusions about how the realities of supply and demand not applying to the carbon tax? Amazing how one person can be wrong in so many areas!

Commenter

QED

Date and time

June 06, 2012, 10:08AM

I absolutely agree with you Alfred. I think Ross amongst others has made a classic mistake of measuring associations (between educational level, housing tenure etc) and helath and drawn conclusions as to a causative nature. As you point out the root cause may well be something different. This is likely to lead to the failure of an 'educational approach' to poor health much as it has alwyas hindered a medical/public education approach.

Commenter

Doc

Date and time

June 06, 2012, 10:12AM

Sugar, diet and other lifestyle factors have minor influence on longevity and health.

The research clearly has identified "psycho-social" factors as the major influence.

See more at http://beliefinstitute.com/article/factors-employee-health-wellbeing-and-resilience

Commenter

Sp100

Date and time

June 06, 2012, 10:19AM

"Doctor Karl has refuted this ..."

Well if so he is wrong.

World Health Organization report:

"Even in the most affluent countries, people who are less well off have substantially shorter life expectancies and more illnesses than the rich. Not only are these differences in health an important social injustice, they have also drawn scientific attention to some of the most powerful determinants of health standards in modern societies. They have led in particular to a growing understanding of the remarkable sensitivity of health to the social environment and to what have become known as the social determinants of health."

No, the "lower" classes are poor because our economic system can only support a very small "upper class" that, in itself, creates no wealth. But our economy uses almost ALL of the wealth CREATED BY THE "LOWER CLASSES" in supporting the poor choices of the "UPPER CLASSES". This problem is made much worse by the innate tendency of our economic system to promote and exacerbate inequality until the wealth is so concentrated that demand collapses and we end up in recession and depression.

The problem with your little theory is that, under the right social circumstances, people with much lower incomes than those you would consider to be "of the lower classes" in Australia regularly make better health choices and enjoy far better health than the comparitavely wealthy poor in Australia. According to WHO data, the health of the average Cuban citizen is superior to that of the average Australian citizen, and the main reason for this is that the average Cuban citizen lives in a society that caters first and foremost for the needs of its citizens.

The Cubans have organised their society to serve their needs, rather than relying as we do on a "trickle-down" of benefits from the activities of corporations. Cubans have access to fresh food close to their homes because fresh food is grown close to their homes. All Cubans live within walking distance of a GP surgery and all have free access to a world-class health system.

The "lower classes" in Australia make poor choices because they are largely denied access to the "good choices". Cuba does not have a "lower class" because ALL of its citizens have access to the things they need to make "good choices". And it works.